The syndemic of COVID-19 and methanol poisoning in Mashhad, Iran

Background At the beginning of the COVID-19 epidemic in Iran, ethanol shortages and the false belief that drinking alcohol could prevent infection led to a sharp increase in homemade alcohol consumption. Consequently, on some days, hospitalizations due to toxic alcohol poisoning exceeded those related to COVID-19.Objective To describe the epidemiology, clinical characteristics, ocular and neurological sequelae, management, and outcomes of acute methanol poisoning during the early COVID-19 surge in Mashhad, Iran.Methods This cross-sectional study enrolled all individuals with acute methanol poisoning who received standard care. We recorded demographics, medical history, exposure type, time from ingestion to symptoms, initial presentation, methanol levels, acidosis, treatments, outcomes, and COVID-19 status.Results A total of 208 patients with acute methanol poisoning were studied. Most consumed homemade alcohol and presented 24–72 h after ingestion. Forty-four drank alcohol to prevent COVID-19. During hospitalization, 108 developed visual impairment; 45 became permanently blind, and 32 died despite treatment.Conclusions The rapid spread of COVID-19 initially triggered an outbreak of methanol poisoning in Iran. Despite treatment, 87 patients (42%) died or developed permanent complications, and mortality remains high due to delayed hospital admission and diagnosis.